Humana Medicare Advantage Mental Health Coverage Guide
Humana Medicare Advantage is the second-largest Medicare Advantage insurer in the nation, serving approximately 5.5 million Medicare beneficiaries. They are especially strong in the southern United States and have expanded mental health benefits significantly.
Medicare Mental Health Coverage
Medicare Part B covers outpatient mental health services, including individual and group therapy, psychiatric evaluation, and medication management. After meeting your deductible, Medicare typically covers 80% of the approved amount.
How to Verify Your Mental Health Benefits
Before your first appointment, verify your specific benefits so you know what to expect. Here is a step-by-step process for Humana Medicare Advantage members:
- Call 1-800-457-4708 and have your member ID card ready.
- Ask to speak with the behavioral health benefits department.
- Ask: "What is my deductible for outpatient mental health services, and how much have I met?"
- Ask: "What is my copay or coinsurance for an in-network therapy session?"
- Ask: "Do I have out-of-network benefits, and what is the reimbursement rate?"
- Ask: "Is prior authorization required for outpatient therapy?"
- Ask: "Is there a session limit per year?"
- Ask: "Are telehealth sessions covered at the same rate as in-person?"
Know Your Rights: Mental Health Parity Act
Federal law requires Humana Medicare Advantage to cover mental health services at the same level as medical and surgical benefits. If you are denied coverage, ask for the denial in writing and reference the Mental Health Parity and Addiction Equity Act.
Want to keep track of all these details? Use our free benefits verification worksheet to organize your coverage information.
Finding an In-Network Therapist
Search Humana Medicare Advantage's provider directory directly: Find a therapist in your area
Tips for Using the Humana Medicare Advantage Directory
- Filter by "Behavioral Health" or "Mental Health" specialty.
- Check that the provider is accepting new patients before calling.
- Confirm the provider is in-network for your specific plan (not just Humana Medicare Advantage generally).
- Look for providers who specialize in your specific concern (anxiety, depression, trauma, etc.).
Types of Providers Covered
Telehealth Coverage
Humana Medicare Advantage covers telehealth therapy sessions, so you can meet with a therapist from home via video or phone.
Couples & Family Therapy
Family therapy covered per Medicare guidelines.
Understanding Your Humana Medicare Advantage Coverage
Available Plan Types
Behavioral Health Managed By
Humana Behavioral Health
Some Humana Medicare Advantage plans outsource behavioral health management. You may need to call the behavioral health manager directly for authorizations and provider searches.
Prior Authorization
Generally not required for outpatient therapy.
Substance Use Treatment
Humana Medicare Advantage covers substance use disorder treatment, including outpatient counseling, intensive outpatient programs, and inpatient rehabilitation.
Common CPT Codes for Therapy
These are the billing codes your therapist will use when filing claims with Humana Medicare Advantage:
| CPT Code | Description |
|---|---|
| 90791 | Psychiatric diagnostic evaluation |
| 90834 | Individual therapy (45 minutes) |
| 90837 | Individual therapy (60 minutes) |
| 90847 | Family / couples therapy (with patient present) |
| 90846 | Family therapy (without patient present) |
| 90853 | Group therapy |
How to Get Reimbursed (Out-of-Network)
If you are seeing a therapist who is not in Humana Medicare Advantage's network, you may still be able to get reimbursed. Here is how:
- Pay your therapist directly at the time of your session.
- Request a superbill from your therapist after each session. This is a detailed receipt with the information Humana Medicare Advantage needs to process your claim.
- Submit your claim to Humana Medicare Advantage using one of these methods:
- Online: Submit through the member portal
- Mobile App: Submit via the Humana Medicare Advantage app
- Fax: 1-877-260-3498
- Mail: Humana Medicare, P.O. Box 14601, Lexington, KY 40512-4601
- Wait for processing. Most claims are processed within 30 days. You will receive an Explanation of Benefits (EOB) showing what was covered.
What Your Superbill Should Include
- Therapist's name, credentials, NPI number, and tax ID
- Date of service
- CPT code (e.g., 90834 or 90837)
- ICD-10 diagnosis code
- Amount charged
- Your name and date of birth
Humana Medicare Advantage tip: Submit through the MyHumana portal. Most Medicare Advantage plans require in-network providers for non-emergency services.
Save Money on Therapy with Humana Medicare Advantage
Use Your HSA or FSA
Therapy is an eligible expense for Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). You can use these pre-tax dollars to pay for copays, coinsurance, and out-of-network therapy costs, effectively saving 20-35% on your therapy expenses.
Ask About Sliding Scale Fees
Many therapists offer reduced rates based on your income. If you have a high deductible Humana Medicare Advantageplan or high out-of-pocket costs, ask your therapist about sliding scale options. Some therapists will also offer "single-case agreements" with Humana Medicare Advantage at a negotiated rate.